Question
Is PEP effective if taken 48 hours after exposure?
2 July 2021. Related: All topics, PEP/PEPSE.
I paid for sex with a woman but the condom tore and I only realised after I was done. There is a high chance that she was HIV positive. I started PEP after 48 hours.
I got a PCR test done 17 days after exposure. It had a less than 20/ml (undetectable) result.
Now between 14 and 35 days after exposure I have had signs of thrush, mild red rash on my face and a couple elsewhere. But no fever or swollen lymph glands.
Can the rash and thrush be because of utter stress and obsession?
My doctor says that the PCR can be relied upon and that I am negative.
Can the PEP have reduced the viral load to less than 20/ml as I took it for 15 days before the PCR test?
Please give your expert advice. I am very anxious. Thank you.
Answer
Thank you for your question.
The risk of HIV from one broken condom is very low. If your partner had an undetectable viral load on treatment, then the risk would be zero. If they were not on treatment the risk might still be only 1 in 300 or lower.
You cannot guess someones HIV status so your assumptions might also be wrong.
You started PEP within 48 hours, so it is likely it will work.
PEP – stands for Post-Exposure Prophylaxis. It is a term used for taking HIV drugs to reduce the risk of infection. PEP usually involves taking a combination of three HIV drugs for one month. The earlier PEP is started, the more likely it will work. Ideally, this should be within a couple of hours. If this is not possible, then still the earlier the better.
Some guidelines include a two-day window to do this (i.e. within 48 hours). After this, effectiveness is much less likely. Other guidelines allow up to 3 days (i.e. within 72 hours). Sometimes this may be more for psychological benefit. For example, if someone is very stressed or traumatised.
No guidelines recommend starting PEP after 72 hours.
After finishing PEP you need to wait a 4-6 weeks before testing.
If the PEP has worked, or the person was not initially infected, this will show as a negative HIV test. The test you did 17 days after the exposure will not be accurate yet.
If the PEP has not worked, this will be shown in a positive test result. Testing 4 weeks after PEP will detect 95% of infections. Testing after six weeks will detect more than 99% of infections. This result doesn’t need to be tested again.
If PEP has not worked, serosonversion usually occurs 1-3 weeks after PEP is finished. However, only 80% of people show symptoms.
Please test 6 weeks after you finished PEP is finished. If you test any earlier, you need to take a second test 3 months later.
Viral load (PRC) tests are not approved to test for HIV. In some cases they can have a role.
Please see a doctor to talk about your symptoms he best way to confirm what is causing them is to see your doctor. He/she will be able to diagnose and treat the symptoms accordingly.
Note: This answer was last updated in July 2021 from an original post from December 2011.
Hi A, these are still non-suggesting symptoms. They are not specific. This means they can be caused by any number of things. Have you had symptoms like this before? Your doctor is right. While on PEP you will need to wait to test. The earliest you can test for a confirmatory result is 6 weeks after your last dose of PEP. Aerius is a medication used to manage allergic symptoms. Have your symptoms gone away since starting this? Oral sex carries little to no risk of transmission. There has never been a case of documented transmission via an oral route. This is supported by saliva being anti-viral. This means it is very difficult for HIV to survive in saliva.
PEP does not reduce the risk to zero. PEP has an effectiveness of around 80%. But this is in cases of true transmission risk. Given your route of exposure was very low risk, the chances of PEP working is higher.
Hi I’m A again. Thanks for replying me josh. I’ve concerned one more thing which I encountered now. Now it’s 19th day of my PEP and in present my body is itchy. I found some red rashes at my back and also on neck. As I mentioned earlier comment, I’m still having feeling like ill, weird in mouth, nausea and body weakness. Are these the symptoms of HIV first stage? I’m still scared. 4 days ago, I went to doctor who gave me PEP. He said I can not test the HIV as I’m on PEP treatment. He gave me Aerius 5mg and instructed me to take one pill every morning till the end of my PEP course. May I know is that really no risk at all by giving oral sex to commercial sex worker? I measure my body temperature everyday which always around 36.5-36.9 degree Celsius. But sometime I feels like cold and having ill. Please kindly reply . May god bless you.
(P.S sorry for my bad english as it’s not my mother tongue)
Hi Medo, it is good that you have been to a doctor. Is your high BP being managed? and did the doctor address any of your other symptoms? Has this weakness been for as long as you’ve been on PEP? 18 days is still very soon for noticeable regression of weight. Have you been eating and drinking well while you have been on PEP?
thank you for replying . I don’t think I lost a lot of weight, but I noticed weakness in my stomach, waist, arms, and face. I suffered from a regression of fat in those areas. Today I was visiting the doctor because yesterday I was feeling sweaty and chills in addition to a lump in the throat. She measured my blood pressure and found it high, while my normal body temperature was 36.4 degrees Celcius .
Hi Japhet, yes. Taking PEP within 72 hours of the exposure will mean that it is effective. As you started PEP within 24 hours it will still be effective.
Hellow I have a question if I take PEP withing a 24hours after sex with some one who effected to HIV…IS IT WORK EFFECTIVE.
Hi Meda, do you know how much weight you have lost? 18 days is very quick to have noticeable changes and should be checked by a doctor if it is a large difference. This is also true for the appearance of liver spots. All of your symptoms could be explained by the stress and anxiety around HIV. Though as you have multiple, you should speak with a doctor about how best to manage these symptoms.
thank you for replying . I do not know if the girl was infected or not, but she is a girl who goes with anyone and takes drugs with the homeless, which means it is highly likely that she is sick… The needles that I took with the medicines after exposure are anti-syphilis, I think, in addition to two pills of Zithromax and 6 pills of Medicine I think against Trichomonas. I took them once, in addition to taking two pills at the same time of post-exposure prophylaxis (tinofavir diproxil furmate & lamvidovine) with doltugravir once a day. On the seventh day, I felt back pain. I went to a doctor and he gave me two needles for pain. I was afraid that it would affect the effectiveness of the medicine, so I doubled the dose that day. In the first days I had frequent urination with painful urination. What worries me is the appearance of liver spots in my arms and the loss of fat in my face, arms and abdomen, as well as tightness in the throat with chills similar to feeling cold or when a person is afraid or when you feel a bout of fear + insomnia and hemorrhoids with descent I am on the 18th day after taking tld pep. Are the symptoms that you mentioned are the side effects of the drugs?
Hi Stella, as this person was taking treatment it is likely was was no/little risk to you. Being on treatment will mean their viral load is suppressed and it is difficult for HIV to be transmitted. As you started PEP so soon after exposure, the risk of transmission is further reduced. There are other factors that change risk as mentioned here: https://i-base.info/guides/testing/risks-for-transmission In the UK this would be considered low risk and PEP not advised.
Hi….am on 28th day of my pep,have no side effects am very ok en I know very well the person was hiv positive, I found ARVs in his house after we slept with him with no protection,I took an Acton I rushed to the hospital I started pep after 18hours am I safe